Stigma and Eating Disorders

An abundance of studies has highlighted the degree to which mental illness is still subjected to stigmatisation. Eating disorders are classified in the DSM as psychiatric disorders, which, like other mental illnesses, makes them prone to be stigmatised within society.

Research examining public opinions on eating disorders suggests that eating disorders are often believed to be the choice of the individual affected by them. Characteristics attributed to people with eating disorders include “vain, self-centred, fragile, unreliable, attention-seeking, or even annoying”. Studies carried out on the general public highlight that there is a belief that people with eating disorders can “pull themselves together”, “have only themselves to blame” or are “likely to be acting this way to get attention”. In light of the widely held belief that maintaining a healthy body weight is desirable, these results may be an indication for the perception that having an eating disorder is simply an extreme effort in this context of maintaining one’s body shape, therefore reflecting the belief that having an eating disorder is a life-choice. Eating disorders are consequently frequently considered less serious than other mental health issues and trivialised.

People with eating disorders have a reputation of being difficult to treat. Studies have shown that treatment professionals working with eating disorder clients hold negative attitudes and beliefs about this service user group. There is also evidence that there is a reluctance to treat people with eating disorders, often attributed to the associated medical and psychological consequences of eating disorders, to the ambivalence of people with eating disorders with regards to treatment and change, or to the stigmatisation of these conditions. Several studies have indicated that many treatment professionals, too, believe that eating disorders are a lifestyle choice.

The tendency to hold people with eating disorders responsible for their condition can result in significant negative consequences. Generally, individuals that are blamed for their condition are more likely to generate anger (as opposed to empathy or compassion) and less likely to bring out helping behaviour in others than those with conditions that are considered outside their personal control. The negative attitudes of treatment professionals can negatively impact on the relationship between therapist and client, and consequently on treatment outcome, as well as the quality and the availability of eating disorder services. Additionally, mental health literature has indicated that one of the consequences of being stigmatised is a reluctance to seek and engage in treatment. This has been found to be true in the context of eating disorders also, where studies have indicated that both stigma and shame and a fear of negative attitudes on behalf of treatment professionals can act as a barrier to seeking treatment.

There is therefore a need for community-wide interventions that address the stigmatisation of eating disorders as well as the misconceptions about eating disorder treatment. This includes raising awareness about the distress and dangers that accompany all types of eating disorders, their seriousness compared to the perception that they are trivial, but also of conveying the message that recovery is possible.

For treatment professionals, the NICE Guidelines and the Vision for Change Report stress that stigma can be reduced by providing a service user-centred environment with a strong therapeutic relationship. Both argue that there is a need for more training programmes to increase the skills of clinicians in the eating disorder area and subsequently their confidence in working with this client population.

In light of the self-stigma experienced by people with eating disorders there is a need to also target the empowerment of people affected by these conditions. This will encourage them to believe that they can recover and achieve their life-goals and enable a more recovery-oriented relationship between treatment providers and service users.